Life Span and Disability

Psychiatric functioning and disability have historically been considered separate from the broader disability field and have been measured differently than other medical conditions. This paper provides an overview of the current concepts and international advances in the classification of psychiatric disability and explores the controversies and goals within the proposed systems. It highlights key aspects of the role of disability and functioning in major psychiatric classification systems (including ICD-10/ICF, DSM-IV) and international programmes such as the Institutional Program for Psychiatry for the Person (IPPP) of the World Psychiatric Association. It stresses key studies on the impact of psychiatric illness in the overall functioning of individuals. Narrative review of studies providing details of key aspects of controversial issues is presented throughout the article. ADL (Activities of Daily Living) and ICF (International Classification of Functioning) are two different models of disability which have different implications for the assessment of mental disorders. Within ICF, ‘environmental’ and ‘personal’ disabilities have been defined. In mental health, disability and functioning are part of two separate and theoretically complementary classification systems: the diagnostic system and its consequences on functioning and activity. Thus, a mental disorder may be determined by the level of dysfunction, particularly in DSM. Although no system currently available properly captures the complexity * Received: 26 February 2010, Revised: 20 May 2010, Accepted: 24 May 2010. 1 Dept. of Neurosciences. University of Cadiz, Plaza San Marcos 6, Jerez 11403, Spain. E-mail: [email protected] 2 Mount Sinai School of Medicine at Elmhurst Hospital Center. New York. USA. E-mail: [email protected] 7 Life Span and Disability / XIII, 1 (2010), 7-27 The role of functional disability in psychiatric classification Luis Salvador-Carulla1 & Vladimir I. Gasca2 of the assessment of disability and functioning, the ICD-10 approach is conceptually more advanced than DSM-IV. Functional disability has significant implications in the holistic classification of mental disorders, particularly in the development of the World Psychiatric Association’s IPPP